To be seventy years young is sometimes far more cheerful and hopeful than to be forty years old

Oliver Wendall Holmes

You are here » Home » Conditions » Knee Conditions

Knee Conditions

Quick links to:

Knee Arthroscopy ACL Reconstruction Total Knee Replacement

Knee Arthroscopy

Knee Joints

The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone (femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur.

Four bands of tissue, the anterior and posterior cruciate ligaments, and the medial and lateral collateral ligaments connects the femur and the tibia and provide joint stability. Strong thigh muscles give the knee strength and mobility.

The surfaces where the femur, tibia and patella touch are covered with articular cartilage, a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous-cartilage tissue called the lateral and medial menisci act as shock absorbers and stabilisers.


Arthroscopy is a minimally invasive operation to repair a damaged joint; an examination of the joint with an arthroscope while making repairs through a small incision.

Tiny instruments capable of cutting or shaving material are inserted through incisions of less than 1cm in length. A miniature camera in the arthroscope views the inside of the knee on a monitor, allowing for diagnosis of the injury and surgical correction of the problem.

When indicated, corrective surgery is performed for conditions which may include:

  • Torn cartilage
  • Damage to kneecap (patella)
  • Torn ligament
  • Arthritis


Removal damaged meniscus


Debriding loose cartilage


Removal spurs to encourage cartilage regrowth

Removal of loose bodies

Loose debris which are pieces of bone or cartilage loose within the joint and are formed from direct trauma to the joint surfaces.

Patellar lateral release

Patellar maltracking (when the kneecap abnormally pulls towards the outside of its groove) may cause irritation to the cartilage and pain may occur. The most common is when the kneecap does not glide well, a lateral release procedure is used to help realign the kneecap.


This condition refers to softening of the articular cartilage of the knee cap. It usually occurs most often in young adults and can be caused by injury, overuse, malalignment, or muscle weakness.

The knee cap rubs against the lower end of the thighbone, instead gliding smoothly, thereby roughening the cartilage underneath the knee cap.

Knee Arthroscopy Post-Op

Post Operative Instructions

  1. All outer bandages should be removed within 24 hours, but leave the inner dressings intact, for 5 days following surgery. If they come off inadvertently, or become soiled, then a simple bandaid will suffice.
  2. Keep dressings dry. If not a waterproof dressing, then shower with a plastic bag for the first five days.
  3. A simple analgesic such as Panadol, Panadeine or Digesic will be provided for pain relief. Two tablets taken 4 hourly is recommended. Anti-inflammatory medication may be prescribed for you following your arthroscopic surgery. A script will be provided.
  4. It is usually possible to take weight on the operated leg. In the first few days post-operatively, walking may be painful. Please keep this to a minimum.
    For the first 48 hours, the affected limb should be elevated, with the joint above the level of the heart. This is ideally achieved by lying flat, with the leg elevated on the pillows. Please keep as mobile as possible.
  5. Commence applying ice to the knee immediately. ½ hour on and ½ hour off all day for 3-4 days. Reapply Tubigrip stocking between ice treatments.

Rehabilitation Exercises - Post Op

Wasting of the quadriceps musculature invariably occurs following injury and surgery. It is essential that the strength in this muscle group is restored as rapidly as possible. This can usually be commenced immediately following your surgery.

Exercises are performed lying on a flat surface. The unaffected knee is bent to 90 degrees, in an attempt to reduce stress on the lumbar spine.

  1. With the leg straight, and the toes pointed vertically towards the ceiling, the quadriceps muscle is tightened. This is a maximal contraction.
  2. Maintain that contraction for a period of 2 seconds, then raise the operated leg to the height of the non-operated knee.
  3. Raise the leg slowly over 2 seconds, then raise the operated leg to the height of the non-operated knee.
    A single leg raise should take approximately 6 seconds, maintaining maximum voluntary contraction.
    Perform 10 raises then have a break. Repeat 8 sets of 10 raises.
    This should be performed twice daily, increasing to 3 times over the next few days.
    If it is not possible to raise the affected leg, then tightening the quadriceps muscle with the leg straight, and maintain that contraction for 6 seconds is recommended, until a leg raise is possible.

Post Operative Appointment

An appointment for post operative review will be given to you when your surgery paperwork is completed.

Your review appointment is 10-14 days following your surgery.

Dr Morgan will discuss your surgical findings at this appointment.


Knee Conditions

If you experience any of the following, please contact us during office hours or out of hours contact an after hours medical practitioner/hospital:

  • Fever
  • Chills
  • Persistent or increased pain
  • Increasing pain in your calf muscle
  • Persistent warmth or redness around the knee
  • Significant swelling in your knee
  • Shortness of breath or chest pain

ACL Reconstruction

Knee Conditions

The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone (femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur.

There are four main ligaments connecting these two bones:

  • Medial Collateral Ligament (MCL) -- Runs along the inner part of the knee and prevents the knee from bending inward.
  • Lateral Collateral Ligament (LCL) -- Runs along the outer part of the knee and prevents the knee from bending outward.
  • Anterior Cruciate Ligament (ACL) -- Lies in the middle of the knee. It prevents the tibia from sliding out in front of the femur, and provides rotational stability to the knee.
  • Posterior Cruciate Ligament (PCL) -- Works in concert with the ACL. It prevents the tibia from sliding backwards under the femur.

The ACL is located in the center of the knee joint and runs from the femur (thigh bone) to the tibia (shin bone), through the center of the knee. In this position, it functions to prevent a buckling type of instability of the knee.

How is the ACL injured?

ACL tears may be due to contact or non-contact injuries. A blow to the side of the knee, such as may occur during a football tackle, may result in an ACL tear.

Alternatively, coming to a quick stop, combined with a direction change while running, pivoting, landing from a jump, or overextending the knee joint, can cause injury to the ACL.

Football, basketball, netball and skiing are common causes of ACL tears.

Signs you may have sustained an ACL tear:

Knee Conditions
  • Giving way or instability of the knee
  • Hearing a 'pop' at the time of injury
  • Sudden swelling of the knee joint
  • Pain in the knee when walking

Determining an ACL tear

Usually, a clinical examination is undertaken to determine if an ACL tear has occurred.

In cases of a suspected ACL tear, an MRI may help to determine the diagnosis, and evaluate if there are other injuries to the knee, such as other ligaments or cartilage.

Surgical versus Non Surgical

In a fit, active individual surgical repair is recommended to maintain an active lifestyle which involves running and pivoting.

For someone who does not wish to maintain an active lifestyle, possible arthroscopic assessment may be recommended if they are experiencing catching or locking problems.

ACL Graft Options

Hamstring tendon graft

The hamstring tendon (in the back of the thigh) is usually utilised for grafting for a primary (first) ligament rupture. The tendon is harvested to create a graft. A tunnel is created and the graft is placed through the tunnel and secured with anchor fixation. The advantage of hamstring tendon is faster recuperation and less pain in the front of the knee.

Patellar tendon graft

Using the central 1/3 of the patellar tendon, the tendon connecting the kneecap (patella) to the shin bone (tibia), to fashion a new ligament. When the graft is 'harvested,' a piece of the bone of the patella and tibia is also taken and therefore the attachments of the tendon to the bone are not disturbed. When the graft is placed into the knee, this allows for 'bone to bone healing.' This is felt by many surgeons to be the most secure graft type. The primary disadvantage is knee pain following the surgery.

How is the ACL reconstruction repaired?

During arthroscopic ACL reconstruction, several small incisions—usually two or three—around the knee. Sterile saline (salt) solution is pumped into the knee through one incision to expand it and to wash blood from the area. This allows us to see the knee structures more clearly.

The surgeon inserts an arthroscope into one of the other incisions. A camera at the end of the arthroscope transmits pictures from inside the knee to a TV monitor in the operating room.

Knee Conditions

Surgical drills are inserted through other small incisions. The surgeon drills small holes into the upper and lower leg bones where these bones come close together at the knee joint. The holes form tunnels through which the graft will be anchored.

The surgeon will take the autograft (replacement tissue) at this point either hamstring or patellar tendons can be utilised.

The graft is pulled through the two tunnels that were drilled in the upper and lower leg bones. The surgeon secures the graft with screws or staples and will close the incisions with stitches or tape. A temporary surgical drain may be put in place. The knee is bandaged, and you are taken to the recovery room for approximately 30minutes and then back to your room.

During ACL surgery, other injured parts of the knee may be repaired including the meniscus, cartilage, etc.

ACL Reconstruction Risks

ACL reconstruction surgery is generally safe.

ACL Reconstruction Complications

  • Graft failure - 5- 10%
  • Infection - <1%
  • Stiffness - 1-2%
  • Venous thrombosis (DVT)
  • Osteoarthritis - natural history is comfortable for you.

ACL After Surgery

Day 1 - 14

Brace and crutch protection is essential for three weeks following surgery.

Simple leg raising and gentle supported range of motion exercises are recommended within this period. Your physiotherapist will establish this program in hospital and will review you one week after surgery.

Staples removed 12 to 14 days following surgery.

2 - 6 weeks

Active and increased ranging to regain range of movement.

Gradually introduce weightbearing exercises, bike, leg press, gentle lunges and mini-tramp (3-4 weeks)

No resisted hamstring exercises until 6 weeks

Pelvic and ankle control

Gait re-education

6 - 12 weeks

This is the period where graft remodelling occurs. That is, the graft is at its most vulnerable state. Caution needs to be observed until the end of this period.

Progress resisted gym work including hamstring

Normal bike ride riding

Aerobic fitness

Pool work with knee locked straight

12 weeks - 6 months

Aim for return to sport 9 to 12 months

Low impact and step aerobics

Pool work -progressive

More resistance work

Plyometrics after 5 to 6 months

Level jogging if adequate quad strength and only with Dr Morgan’s instructions

6 - 12 months

To regain adequate muscle control, strength must be recovered.

Gym program and supervised exercise programs are recommended.

Exercises to regain joint position, sense and control begin.

Sport specific program

ACL Pain Management

Everyone feels pain differently. As a result, you are the expert in understanding your pain experience. You play a major role in managing any pain you may have following your total knee replacement surgery.

You may not be pain free after surgery, only you can say what level of pain is comfortable for you.

VITAL ROLES in managing your post surgical pain:

  1. Prepare yourself. The more prepared you are, the more in control you will feel. Ensure that you understand your pain control and options. Mention any measures that have worked before and any medicine allergies you may have.
  2. Describe your pain. You are the only one who knows how you feel. After your surgery make sure that staff and carers understand the intensity of pain (that is, 0-no pain, 10-worst pain), where the pain is located, and what the pain feels like (sharp, crampy, achy, burning, etc).


You will be sent home from hospital on medication for pain relief and anti-inflammatory medication.

Plan to take your medication 30 minutes before exercises. Remember that preventing pain is easier than chasing it. If pain continues to be a problem, then you need to contact our office.


If you require any further prescriptions for these medications, please do not hesitate to contact our office. A script can be provided simply with a telephone call but try to allow two (2) days approximately two (2) days before your medication is about to run out for a script to be provided.

Total Knee Replacement

Disease of the knee

The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone (femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur.

Disease of the knee

There are a number of causes that can lead to disease of the knee joint. The most frequent is pathologic wear of the joint cartilage: osteoarthritis and arthrosis.

A distinction is made between primary (idiopathic) osteoarthritis, the causes of which are still largely unknown, and secondary osteoarthritis, which appears as a sequel to a known underlying disease, for example, rheumatism, or circulatory disorders of metabolic origin.

Congenital or inherited deformities of the knee joint and accidents are further causes, which lead to injury to bones or joint parts. Ultimately, all these changes lead to destruction of the cartilage layer. This causes direct bone-to-bone contact, partial death of the bone and deformation of the joint with inflammatory, painful consequences.

different knees

You may be well aware of the symptoms:

  • Pain on walking
  • A progressive reduction in walking distance
  • Rest pain
  • A reduction in general mobility of the knee joint.

The pathologic changes can only be shown by x-rays. The actual cartilage cover cannot be seen in the picture. Sometimes an MRI is necessary to determine the extent of change within the knee.

When all operation-free treatments such as physiotherapy, analgesic medication and anti-inflammatory medication have been exhausted, knee replacement surgery, either total or partial, may have to be considered, which will usually offer freedom from pain and a restoration of mobility.

What's involved in a total knee replacement (TKR)

In principle, total knee replacement is the replacement of the diseased joint by an appropriate implant. Knee replacement is NOT excision of the knee joint, but rather a resurfacing of disease joint lining.

What's involved in a total knee replacement

Unicompartmental knee replacement is the replacement of one compartment of a diseased joint by an appropriate implant.

A prosthesis is designed to simulate the human anatomy.

The materials used for the joint replacement are alloys and polymers that have been specially developed for medical purposes. They present good tissue tolerance and allow the function to be as painless and lasting as possible.

The joint components, ie, the joint surfaces in direct contact with each other, comprise a metal femoral component articulation against a polyethylene gliding surface made of high density polyethylene.

The polyethylene is often the weak point of knee replacement. Its wear of failure is frequently the reason why a knee replacement needs to be redone. This is not anticipated for 10 to 15 years, but needs regular review.

When do you need a knee replacement

What's involved in a total knee replacement

The choices for treatment of this condition are based almost entirely on the level of pain experienced. If the pain is not distressing and not greatly affecting your lifestyle, then treatment with simple measures, such as pain killers (Aspirin or Panadol), anti-inflammatory drugs may be all that is necessary.

A walking stick, knee support or knee brace, and occasional physiotherapy, may also be helpful in reducing the level of symptoms.

When, and if the pain becomes intense and significantly affects your lifestyle - your sleep and ability to walk, shop, play golf or bowl, etc - you may need to consider a knee joint replacement.

What are artificial knee joints made of?

Materials used for artificial joints are highly developed. They provide maximum tolerance and long term acceptance by the human body, which is called biocompatibility.

Metals play a vital role in manufacturing artificial joints. Implants are subjected to very high loads inside the body. As a consequence, they must feature advanced material strength in order to take all the load cycles during the many years of use.

How is the implant affixed in the body?

Generally, implant systems are affixed to the body in one of three ways.

  • Cemented with bone cement
  • Cementless (biologic ingrowth)
  • Combination of both

The decision as to whether to use a cemented or cementless component depends upon many factors, including the intended use of the product, surgeon philosophy and the patient's condition.


Providing the highest professional standard othropaedic management and surgical expertise in a personal and caring manner.
  •  (07) 3812 3855
  •  Suite 3, 10 Pring Street, Ipswich, QLD 4305
    Monday - Thursday 8:30am to 5:00pm
    Friday 8:30am to 3:00pm